STATE OF WASHINGTON



348615022860000STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESDevelopmental Disabilities Administration * P.O. Box 45310 * Olympia, WA 98504-5310DDA MANAGEMENT BULLETIND20-010 – ProcedureMarch 17, 2020TO:DDA Field StaffFROM:Debbie Roberts, Deputy Assistant SecretaryDevelopmental Disabilities AdministrationSUBJECT:Assessment and Person-Centered Service Planning Process during COVID-19 OutbreakPurpose:To notify the field about temporary policy changes regarding face-to-face assessments, required visits, person-centered service planning, and service extensions during the COVID-19 outbreakBackground:On February 29, 2020, Governor Jay Inslee declared a state of emergency in response to the COVID-19 crisis, directing state agencies to use all resources necessary to prepare for and respond to the outbreak. DDA staff have been in communication with the Centers for Medicare and Medicaid Services (CMS) to review the rules related to 1915(c) Waivers, 1915(k) CFC State Plan Services and PASRR, and to request exceptions to specific rules until the COVID-19 pandemic is contained.What’s new, changed, or Clarified:To ensure the health and safety of clients and staff during the COVID-19 state of emergency, the requirement to complete an in-person visit as part of the person-centered planning process, and any other required visits, may be waived and services can be extended beyond the end of the client’s current plan year, if needed. ACTION:Effective immediately and until further notice, for all assessment types in all programs, the use of telephonic or other technological devices may be substituted for in-person visits as appropriate. DDA case/resource managers (CRMs) must do all of the following.Evaluate whether an in-person assessment should be completed based on the health and safety needs of clients. When contacting clients to schedule their person-centered service planning meeting, CRMs should let clients know that face-to-face meetings are being discouraged during the COVID-19 crisis and ask them if they would agree to completion via telephone or other electronic method. If the client requests a face-to face assessment, the client should be given that opportunity when one can occur safely. If there is a reason to believe a face-to-face visit needs to occur because of health and safety concerns for the client, CRMs should discuss the situation with their supervisor to determine the best plan of action. Professional judgement should be used to make a final determination on whether an assessment is conducted in-person or telephonically, taking into consideration the health and safety of the worker, the client, guidance from local public health officials, and workforce capacity. Remote AssessmentsIf it is determined that an in-person visit cannot be done, the case manager will complete the person-centered service plan via the telephone or another form of audio or video communication. When completing assessments and service plans remotely:An SER is required. Document this by writing “COVID-19” in the subject field of an SER, and “Home visit will be temporarily waived as a result of the COVID-19 state of emergency” in the body of the SER. The SER should briefly document: Any known information about client’s or household member’s COVID-19 status gathered during the pre-visit questions. How the client’s critical needs are being met, whether by formal or informal providers. (E.g. are paid providers able to meet the needs to the same extent as they have been, and if not, are there informal supports meeting those needs.)Emergency plan in case providers are unable to meet the client’s needs.Process CRM will review all assessment questions with the client or the client’s representative over the phone and use a telephonic interpreter when needed. In the Place of Assessment field, select “Other” from the dropdown and in the Place of Assessment Name type “Telephone-COVID-19.”When the assessment is completed over the phone, the MMSE cannot be performed. If the MMSE could have been completed if in person, the assessor will select “No” to the question, Can the MMSE be administered to the client? Note in the MMSE Comment Box that the “MMSE was not completed because the assessment was completed remotely.” The Cognitive Performance Scale (CPS) score will calculate without the MMSE using the Short-Term Memory question. Talk with providers, family, and other collateral contacts to get the information necessary to complete the assessment as usual. During the COVID-19 crisis we can rely on verbal approval of the client or legal representative to authorize services and to share information as needed to implement the plan. Document verbal approval of the services and consent to share information in an SER. All documentation is still required. Send required forms via mail with a postage-paid return envelope or electronically. Do not delay the assessment or its completion because these forms are not signed and returned; however, efforts must still be made to have them returned and included in the client’s file. In-person AssessmentsIf it is determined that an in-person visit is needed and can be completed safely, CRM may complete the assessment and person-centered service plan via the telephone or other electronic means, and then complete a brief in-person visit, including viewing the client’s living quarters. Exercise all safety precautions during these visits, per CDC guidelines.Initial AssessmentsFor Initial CARE assessments, CRMs may complete the assessment and person-centered service plan via the telephone or other electronic means and then do a brief in-person visit before moving the assessment to current, if the pre-visit questionnaire indicates it’s safe to do so. If the pre-visit questionnaire response indicates it is not safe to do an in-person visit services can be authorized prior to an in-person visit occurring. A visit will be required as soon as it is safe to do so.These initial CARE assessments may be sparse, but must ensure that mandatory fields are completed with the minimum necessary to complete a minimal care plan. Staff shortagesIn the event that an assessment cannot be completed either in person or via telephone, all currently authorized services (including ETRs) may be extended temporarily at the current level for up to 60 days as long as the current services continue to meet the client’s needs. In order to do this a Payment Specialist, JRP, QCC, or FSA may need to do a RAC override in CARE.The current Skin Observation Protocol must continue to be followed. Shadow review requirements are temporarily suspended. ATTACHMENTS:\sRelated REFERENCES:Washington State Local Health Departments and Districts Department of Health - 2019 Novel Coronavirus Outbreak (COVID-19) CONTACTS:Jaime BondState Plan Services Unit Managerjaime.bond@dshs.360.407.1567Teresa BodenJRP Unit Managerteresa.boden@dshs.360.407.1503 ................
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